2021 continues to be dominated by the COVID-19 pandemic. As I write this report during half term and the late changing of seasonal colours, we are continuing to see high rates of new infections daily. Thankfully, numbers of patients in hospital are not rising significantly so far, but the effect of the winter months is uncertain. Reassuringly, double vaccination rates in the UK and in our patients is high, and the booster jab programme appears to be going well.
The COncise adVice on Inpatient Diabetes (COVID) resources led by Gerry Rayman continues to provide much good support (https://abcd.care/coronavirus). Existing resources have been updated and new resources such as the post COVID-19 diabetes discharge pathway, risk stratification and follow-up guidance for people being discharged from secondary care have been added. I sincerely hope we do not need much of this in the coming months.
ABCD continues to run our educational programme of monthly webinars featuring a wide range of topics. Members can catch up with our webinars on demand at their leisure via our website at https://abcd.care/abcd-webinars-series and we have aimed to partner with organisations such as YDEF, GIRFT, PCDS and JBDS so that current and future webinars will have wide interest.
This year’s DTN meeting and ABCD Annual Conference proved to be outstanding successes, and we have been delighted with the feedback even though the events had to take place virtually. Over 334 delegates registered for our DTN meeting with 283 attending live and 213 delegates registered for the ABCD conference with 188 attending live. Our thanks go out to all the speakers and faculty for their support in ensuring such high-quality relevant sessions in our flagship events.
During the year we have also run a number of regional meetings and resumed our Consultant Development Programme, which was the first face-to-face meeting for ABCD since the pandemic. We have face-to-face sessions planned at the Diabetes Professional Conference (DPC) in November in London and hope this provides a safe environment for many of us to meet once again. You can also catch the ongoing sessions and workshops with our EXTOD programme (Exercise and Nutrition in Type I Diabetes) https://abcd.care/extod-2021/programme. Fortunately, many events have an ‘on-demand’ facility for more convenient viewing. Our educational programme concludes this year on 2 December with our Southeast regional meeting (https://abcd.care/events/abcd-regional-meeting-south-east).
I am delighted to report that our membership is growing by almost 20% in a year, with more SpRs joining the association, so our future remains bright and thriving. Reassuringly, we have a strong voice and presence with policy makers and stakeholders in the diabetes community. We continue to work with and provide specialist input to other diabetes organisations and the NHS including the RCP, NICE, NHSE, JBDS and many more. Our participation with these organisations helps us ensure that the voice of the specialist diabetologist is featured and carefully considered in new guidance and reports.
One such recent collaboration with the UK Kidney Association (previously known as Renal Association) has resulted in joint management guidelines on monitoring and treatment approaches designed to improve safety and assist in more effective treatment of individuals who have advanced chronic kidney disease requiring dialysis alongside their diabetes. This had led to a number of publications and key updates in 2021 which I would recommend reading. These can be found at https://abcd.care/position-papers.
This year we have further invested in our flagship journal British Journal of Diabetes (BJD) and huge amounts of work are going on behind the scenes to prepare the journal for PubMed submission early in 2022. As part of these preparations, we have updated the BJD website where you can already view our articles ahead of print (https://bjd-abcd.com/index.php/bjd/issue/view/5). Please do submit your work to the BIJD as it has a wide specialist readership. Submission is easy via our portal and we are happy to support those who are new to submitting their work (https://bjd-abcd.com/index.php/bjd/submit-a-manuscript).
This year, in partnership with the Diabetes Care Trust, we have also undertaken a major piece of work to formalise our process for ABCD research grant submissions in line with Association of Medical Research Charity (AMRC) guidelines, and we have already reviewed the first round of grant applications and need to publicise this to everyone who is looking for early research funding. This work is designed to promote and support early clinical researchers in diabetes and is being led by Dr Parth Narendran. Our thanks to him and the entire academic subgroup for their dedication and commitment to this important workstream.
The ABCD Diabetes Technology Network (DTN) continues to grow and thrive. The amazing collection of resources via the ABCD DTN web pages include educational resources from a virtual showroom demonstrating devices and their use, expert views on devices, educational resources for patients, a virtual academy and a series of videos on virtual consulting. This year we have also undertaken a series of webinars on closed loop systems which have been very successful and are available for on-demand viewing. I am delighted ABCD have been asked to audit the forthcoming NHSE closed loop pilot initiative. Thanks go to Professor Pratik Choudhary and his colleagues for their vision and enthusiasm in this important and evolving area.
Make sure you also save the date of 11 January 2022 for our once-in-a-generation meeting to commemorate the centenary of the first administration of insulin into a human. ABCD has ambitious plans for this free special event to be hosted at the Royal College of Physicians in London to commemorate the occasion. Many thanks to Dr Bob Ryder for leading to curate this quite amazing programme.
Our nationwide audit programme continues to go from strength to strength led by Dr Bob Ryder. This year we have published three new publications from the real-world audit of the FreeStyle Libre system (FSL) in people with type 1 diabetes who use FSL. Find out more at https://abcd.care/announcement/three-new-publications-abcd-nationwide-freestyle-libre-audit-published-during-september. The worldwide audit of testosterone deficiency in men with type 2 diabetes has recently been launched so please submit your own data for this global audit, http://www.diabetologists-abcd.org.uk/n3/previous_ABCD_audits.htm. We have an active ABCD COVID-19 national audit group who are analysing and maximising the learning from the pandemic, now with international collaborators. I am sure this work will lead to more exciting outputs with global relevance.
We hope you continue to enjoy our fortnightly newsletters which help keep you abreast of new developments, news, events and other diabetes-related information. If you have news to share with the membership, please feel free to drop us a line at info@abcd.care.
I would like to take this opportunity to thank and acknowledge the hard work of Dr Susannah Rowles, Honorary General Secretary, and Dr Andrew Macklin, Honorary Treasurer who have both completed their terms of office this year. I would like to warmly welcome in Vijay Jayagopal as our newly elected treasurer, whose appointment was recently ratified at our AGM. The role of treasurer is hugely important and mainly goes unseen by the membership, but nevertheless involves a huge dedication and commitment. We will share news of the new incoming general secretary with you very soon.
As chair of the ABCD committee, I would also like to remind everyone and wish to thank all our corporate sponsors of both ABCD and DTN, without whom few of the programmes and supporting activities would be possible. Our sponsors are AstraZeneca, Besins Healthcare (UK) Ltd, Lilly, Novo Nordisk, Abbott Laboratories Ltd, Roche Diabetes Care, Insulet International Ltd, Medtronic Ltd, Medtrum Ltd, ViCentra, Advanced Therapeutics (UK) Ltd, Air Liquide Healthcare Ltd, CamDiab and Dexcom.
Finally, I wish you all a happy, healthy Diwali, Hanukah, Christmas and New Year and hope that you are all able to spend quality time away from work with friends and loved ones. In the meantime, between fireworks and mince pies, do make sure you register for our 100 Years of Insulin centenary meeting (11 and 12 January 2022 at the RCP, London) as numbers are limited. Do join us for a special dinner event on the 11th, which promises to be a fantastic commemoration of this centenary. You can register now at https://abcd.care/events/abcd-meeting-commemorate-centenary-first-administration-insulin-human
Dipesh Patel, ABCD Chair
This JBDS-IP award for 2021 is postponed due to the second wave of COVID-19. The project is led by Umesh Dashora and Erwin Castro.
In view of the second wave and on the suggestion of Dr Rowan Hillson, the subject of the award will be modified to include the fantastic innovations that people have made during this pandemic. The title for the 2022 award will be ‘The Rowan Hillson Inpatient Safety Award – The best interventions: Redesigning, rebuilding and maintaining safe inpatient diabetes care during COVID’. Entries are welcome from September, with the last date in February 2022. Please prepare for a submission in September from your team.
https://abcd.care/announcement/rowan-hillson-inpatient-safety-award-2021-relaunched
Dr U Dashora and co-authors from the CaReMe group have produced guidance for GPs on how to use SGLT-2 inhibitors safely.
Dashora U, et al. Manage diabetes and comorbidities with a joined-up strategy. Guidelines in Practice
Dr Bob Ryder gets a lifetime achievement award (Dipesh Patel)
ABCD would like to congratulate Dr Bob Ryder on his recent Lifetime Achievement Award. Dr Ryder received this award during the 7th International Diabetes and Endocrine Conference for services to MRCP and UK Audits via ABCD. I am sure you will join me to wish him many congratulations on this achievement!
A study from the Commonwealth Fund has ranked health systems in 11 comparator countries against access, care process, equity, efficiency and healthcare outcomes. In terms of overall ranking, the UK health system has moved down from 1st to 4th out of 11 comparator countries. Norway now takes the highest overall rank, despite Norway (10.5%) and the UK (10.2%) having spent similar amounts on healthcare as a percentage of GDP in 2019. The UK ranked 9th out of 11 comparator countries in terms of health outcomes, despite coming 4th for access to care, efficiency and equity. Asthma was one of the diseases used to measure performance with regard to avoidable hospital admissions and population health outcomes.
Institute for Fiscal Studies (IFS) research warns that up to 14 million people could be on NHS England (NHSE) waiting lists by next autumn. The IFS projection comes as NHSE consultant-led referral to treatment figures show how, between March 2020 and March 2021, 7.4 million fewer people joined the waiting list. A record number are currently waiting for surgery with over 385,000 patients waiting over a year, compared with 1,600 before the pandemic. The British Heart Foundation similarly warns that the number of people awaiting heart surgery in England could rise by over 40%, estimating it may take 5 years to overcome the backlog in cardiac care.
Could NHS waiting lists really reach 13 million? Institute for Fiscal Studies (IFS)
https://ifs.org.uk/publications/15557
The current NHS England (NHSE) Chief Operations Officer, Amanda Pritchard, has been announced as NHS Chief Executive with effect from 1 August. Prichard was previously the Chief Operating Officer of NHS England, and Chief Executive and Chief Operating Officer of NHS Improvement for two years, from July 2019 to July 2021. Before working for NHSE, Pritchard was Chief Executive of Guys and St Thomas’ NHS Foundation Trust for two and a half years.
https://www.england.nhs.uk/2021/07/amanda-pritchard-appointed-nhs-chief-executive/
A UCL study has found that more than one in three UK adults aged 46–48 years have at least two chronic health conditions including poor mental health and diabetes. 34% of this cohort (N=7,951) had multiple chronic health problems, with 21% having recurrent back issues and 19% with mental health problems. 16% reported high blood pressure, 12% asthma or bronchitis, 8% arthritis and 5% diabetes.
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11291-w
GPs have been told to stop routine blood tests until 17th September and hospitals must cut the number of tests by 25% in response to a shortage of blood collection tubes. Shortages are said to be due to ‘UK border challenges’ as well as a surge in demand, in part due to COVID testing. Many patient charities have expressed concerns that this would delay the diagnoses for many patients due to cancelled appointments.
A rapid-fire collection (extract) of interesting recent developments in diabetes
It has been a busy few months for the DTN.
Hybrid closed loop pilot project
NHS England announced a project to provide hybrid closed loop therapy to up to 1,000 people with type 1 diabetes through 25 adult and seven paediatric sites as part of a pilot. The ABCD and DTN were closely involved in developing online data collection tools through the ABCD audit system. DTN also hosted a series of webinars led by Dr Sufyan Hussein from GSTT and Geraldine Gallen from KCH to support teams on how to choose the best systems and how to on-board patients to this treatment. The DTN also hosts a weekly catch-up call with all the pilot centres and NHS England, which has been invaluable in ironing out some of the logistical and implementation details that are inevitable with a project like this.
Academy
It has been great to see an ongoing high uptake to the Academy education programme. After a slight dip in August, we have seen a lot of activity on this platform through September. It is great to see all the work we put into this platform being used by clinicians and been heart-warming to receive the messages of support showing how useful this has been for teams across the country. We are working to make this a desirable addition for all trainees in Diabetes & Endocrinology and we should be sharing the data on uptake in different departments with the team at NHS England. It was great for Academy to be nominated as a finalist for the annual QIC awards.
Expert opinions on devices
In this virtual world, supporting people with diabetes on the choice of device has become even more difficult. They are not able to have a look at devices and handle them before choosing. To try and help teams support patients through this, we filmed a series of videos on expert opinions on devices with two experienced educators. Sara Hartnell from Cambridge and Geraldine Gallen from King’s provide their opinions on the pros and cons of all the different devices available currently.
Annual DTN day
We ran our annual conference, twinned with the ABCD Conference, on Wednesday 13th October. We were hoping so much that we would be able to hold this meeting face-to-face but, sadly, the COVID-19 situation meant that we had to run it virtually again this year. The silver lining to running the meeting virtually was that we actually had a lot more attendance than we would have had face-to-face. We had over 350 people registered for the meeting and attendance levels were over 250 for most of the day. We had a fantastic programme with a number of great presentations covering closed loops, connected pens, the latest glucose monitoring data in Scotland and finishing up with valuable talks on type 1 diabetes and eating disorders, as well as how to manage hypoglycaemia that is resistant to treatment with technology. A focused meeting report will follow in the next issue.
Dr Pratik Choudhury
Diabetes Technology Network UK
Contact: pratik.choudhary@leicester.ac.uk
YDEF continues to develop from the recent pandemic period in strong form, under the leadership of Giulia Argentesi. The committee held their first face-face meeting following the recent restrictions with exciting future plans ahead. New committee members have been interviewed (watch this space) and new positions created on the committee to better represent trainees including our first less than full time training rep, an international medical graduate representative and a deputy chair and a future IMT representative. This will allow YDEF to fully embrace the changes ahead for trainees and NHS in general.
We were delighted to lead a heavily oversubscribed diabetes technology course working directly with ABCD DTN – a unique residential course that allows people to wear diabetes devices to experience what the patients we care for live with on a daily basis. As ever, the feedback from the course was fantastic and we are truly grateful to the speakers who attended and gave their insights. Noting the very high demand for the course, we are signposting the other great diabetes technology courses available and look to run an additional course this year to meet demand.
We have launched our first ever Marjorie Award looking to recognise junior doctors and medical students who have worked to reduce healthcare inequalities in relation to diabetes diagnosis, monitoring and treatment. Marjorie was a dog who was the first animal to ever be injected with insulin, a drug that has transformed and saved so many lives since its discovery 100 years ago. To mark the occasion of the first injection of insulin into a human on 11th January 1922, the Association of British Clinical Diabetologists (ABCD) are hosting a two-day event (11th and 12th January 2022) at the Royal College of Physicians, London, including a celebratory dinner on 11th January. In honour of the 100-year anniversary of insulin and Marjorie the dog, the YDEF Team has launched the Marjorie Prize, with five awardees fully funded to attend this event, awarded to those working to reduce diabetes-related healthcare inequalities.
We hope this year to run our YDEF day in-person, this year asynchronous with the Diabetes UK Professional Conference as a one-off. Watch this space for more information.
Virtual opportunities remain available. ABCD and Lilly have kindly supported the Diabetes Masterclass series which has been incredible with fantastic attendance. The Obesity course held its first of three webinars in the last few weeks and was very well received and over-subscribed.
On behalf of the rest of the committee I would like to thank our outgoing chair Najaf Haider for all his efforts, guidance and leadership during what has been a very turbulent year for YDEF and the NHS as a whole. We look forward to delivering an exciting range of education and advocacy programmes in the face of new challenges, new curriculums and new national guidelines. We are particularly excited to be continually strengthening our relationship with partner organisations such as ABCD and the Society for Endocrinology, amongst others.
Dr Tim Robbins on behalf of YDEF Committee
University Hospitals Coventry & Warwickshire NHS Trust, UK
Contact: timothy.robbins@nhs.net
YDEF is dedicated to all diabetes and endocrine trainees and is open for new members to register on our website. Take advantage of our regular newsletters and up-to-date advertising of a wide variety of courses and meetings to complement your training.
As always, we are continuously looking to develop and propagate our specialty so do not hesitate to contact us if you have any suggestions or questions!